MSK Medicine Flashcards
what is synovitis and what does it indicate
inflammation of a synovial membrane
- common causes include: RA & gout
- can sometimes occur in OA where degen process has caused some inflammation
define stiffness
slowness or difficulty moving one or more joints
what are the likely causes of limited or painful active movement but full, pain-free passive movement
- range of passive movement in usually higher than what the patient can achieve actively
- passive movement does not require the person to use their own nerves, muscles and tendons to produce movement, a reduction in passive range or pain on passive movement indicates a problem with the joint itself (e.g. foreign body, bony deformity, inflammation, contracture)
- in active movement, muscles and tendons to be functioning so problems with these would cause reduced range of active movement
what are the limitations of applying the WHO pain ladder to chronic MSK pain
- risks of side-effects and habituation with prolonged regular use of analgesics
- addiction to opiates
- risk of neglecting non-pharmacolgoical options and rehab e..g physio or psychological pain management approaches
what are mechanical symptoms of the knee and what do they represent
locking or catching of the knee on movement
- previously thought to inidicate problems .e.g loose body or meniscal tear obstructing movement but now these symptoms are quite common even without obstruction
how can bursitis be differentiated from a knee effusion
- knee effusion is swelling due to excess synovial fluid in the joint capsule itself where fluid can be moved across the knee (bulge test) and patellar tap
- in bursitis, swelling is localised to the bursa that is affected e.g. infra-patellar bursitis
what pathology will cause anterior hip pain
‘true’ hip pain e.g. from OA
what pathology will cause lateral hip pain
trochanteric bursitis
what pathology will cause posterior hip pain
lumbosacral spine or gluteal muscles
what is plantar fasciitis
inflammation of plantar fascia - typically causes pain at the insertion of the plantar fascia into the calcaneum (medial calcaneal tuberosity)
what are the symptoms of plantar fasciitis
- pain is marked with the first few steps on getting out of bed and then worsens again to the end of the day
- pain when stretching bottom of foot
- swelling on bottom of heel
what are causes of plantar fasciitis
- repetitive stress
- overweight/obesity
- structural foot deformities e.g. flat foot or high arch
- tight calf muscle
what is the management of plantar fasciitis
- rest the feet where possible
- wear shoes with good arch support and cushioned heels
- insoles and heel pads may be helpful
in metatarsalgia, what would make you suspect a morton’s neuroma
classic finding of morton’s neuroma: tenderness in the inter-digital space where neuroma is located
what features on history and examination can help identify radicular back pain
- typically felt in the dermatomal area supplied by the foot
- commonest pattern is sciatica which radiates to buttock and posterior leg
- pain is often worse when nerve is stretched e.g. in straight leg raise
- pain is described as ‘shooting’ or numb + other neuro symptoms e.g. weakness, ankle hyporeflexia
